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Friday, 13 November 2015

If you were to ask a member of the public to name a particularly healthy cuisine they might say the Mediterranean diet. If they really knew their stuff they might even suggest the Inuit diet. What they are unlikely to mention is the British diet of the mid-Victorian era. Yet between the years of 1850 and 1872 was a mini golden age of nutrition which, if more restricted in choice, had much in common with today’s best dietary models. Their diet may have been dull, but the mid-Victorian urban working classes ate healthily.

A common view remains that Victorian life was brutish and short. A typical life span in 1840s Whitechapel, London, was supposedly 45 years for the middle classes, with the working classes averaging 22 to 27 years. However, these statistics are misleading. For a start, the 1840s — the ‘Hungry Forties’ — was a period of famine. But the figures were also skewed by extremely high infant mortality rates (due to disease, not malnutrition). One child in five died within its first year of life; one child in three within the first five years.

Once those vulnerable childhood years were passed, mid-Victorian life expectancy was not dramatically different from our own. Starting at age five, it averaged 75 for men and 73 for women (reflecting the dangers of pregnancy and childbirth). This compares surprisingly well with present figures, averaged at 79 for men and 84 for women, and indicates that our ‘better’ life expectancy at birth mostly reflects improved neo-natal care. These are crude measures. A more nuanced comparison would be with life expectancy in today’s working and lower-middle classes (socio-economic groups C1, C2 and D) where relevant figures are around 72 and 76 years for men and women respectively. Women have gained three years thanks to family planning; but it is the men’s loss of three years that reveals the true underlying decline in public health.

Health expectancy provides valuable comparative insight. Mid-Victorians enjoyed relatively good health in old age. The elderly then, including workhouse inmates, were physically capable of working until the last few days or day of their lives. Agricultural labourers regularly worked into their 70s. Hospital capacity was limited because of home nursing and a lesser need for non-acute medical facilities. In contrast, men today can anticipate spending the last 7.7 years of their lives in a state of increasing medical dependency: for women that figure is in excess of 10 years. From this perspective, the medical gains of the last century are severely tarnished.

The implications of a better understanding of mid-Victorian health are profound. It becomes clear that, with the exception of family planning, the vast edifice of post-1948 healthcare has not so much enabled us to live longer but has merely supplied methods of controlling the symptoms of non-communicable degenerative diseases, which have become prevalent due to our failure to maintain mid-Victorian nutritional standards. Dysnutrition is arguably the largest cause of ill-health today.

Our study in the Journal of the Royal Society of Medicine (here, here, and here) shows that the majority of the Victorian urban poor consumed diets which were limited, but contained extremely high nutrient density. Bread could be expensive but onions, watercress, cabbage, and fruit like apples and cherries were all cheap and did not need to be carefully budgeted for. Beetroot was eaten all year round; Jerusalem artichokes were often home-grown. Fish such as herrings and meat in some form (scraps, chops and even joints) were common too. All in all, a reversion to mid-Victorian nutritional values would significantly improve health expectancy today.

This has not been hitherto understood, partly because of our faith in the advances of medical institutions and treatments. It has also been obscured by a popular insistence on seeing 1900 as the starting point for medical progress.

In the 1870s Victorian health was challenged by cheap sugar and the first generation of mass-processed high-salt and high-sugar foods. This dragged urban health and life expectancy to a nadir around 1900 — a date that consequently provides a highly misleading baseline. (The trend was even reflected in people’s height. The minimum height for infantry was lowered from 5ft 6in to 5ft 3in, then later to 5ft, in just two decades.)

Charting public health from the mid-Victorian era, our worldview changes dramatically. Mid-Victorians lived without modern diagnostics, drugs, surgery or contraception. Despite that, and because of the high nutrient density of their diet, their life spans were as good as ours and their health spans significantly longer. The dietary advantages of the mid-Victorian period have been lost to us because of our more sedentary lifestyles and over-consumption of processed and nutrient-depleted foods and beverages.

Life expectancy is falling in areas as diverse as Strathclyde, parts of Africa and the former Soviet Union, and within significant social strata in the US. The confident concept of inevitably increasing life expectancy is no longer convincing — the current pandemics of obesity and diabetes represent in many ways an acceleration of the ageing process. We need to go back to the future.

6 comments:

chris c
said...

Excellent stuff! I'll read the papers themselves later.

My theory: so far only a small minority of the population has evolved the ability to eat a high carb low fat diet. Depending how badly your metabolism has been broken by eating such a diet, you may need to go back in time as far as the Paleolithic, but for people less badly broken it may only be necessary to revert to the diet of your grandparents.

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We are a small band of diabetics all low carbers. Posting links to diabetes related articles and low carb food advice. In our spare time we like to lampoon the spreaders of fear and misinformation. Welcome to the crazy world of diabetes.